Category Archives: Medications and Adverse Drug Events

Be ADEPT: An approach to the older patient with confusion or agitation

Older adults often present to the ED for or with confusion or agitation. It is important to have a framework for assessing these patients, diagnosing the presence of delirium or dementia, looking for underlying causes, preventing worsening, treating the underlying … Continue reading

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Are Orthostatic Vital Signs Helpful in the ED?

There is some confusion, disagreement, and misunderstanding surrounding orthostatic vitals in the ED. Older patients have a high rate of incidentally-found positive orthostatic vital signs, typically because of heart-rate changes. So emergency physicians may be reluctant to request orthostatics. However, … Continue reading

Posted in Cardiology and Pulmonology, Medications and Adverse Drug Events, Neurology and Psychiatry, Trauma | 1 Comment

Subdissociative Dose Ketamine in Older Adults? – Maybe

IV subdissociative dose ketamine (SDK) is used with increasing frequency for acute pain management in the ED. However, most studies have excluded older adults in assessing its efficacy and safety. In this episode, Sergey Motov (@painfreeED) discusses his recent paper “Intravenous … Continue reading

Posted in Medications and Adverse Drug Events | 3 Comments

Urinary Infections and Catheters in Older Adults

UTIs, UICs, and CAUTIs in older adults! In this episode, Mary Mulcare, EM and geriatric-EM-trained physician in NYC and I discuss how to diagnose UTIs in older adults, and the confounding factors of asymptomatic bacteriuria, sterile pyuria, and colonization. We … Continue reading

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Trauma in Older Adults

Older adults who suffer traumatic injuries have worse outcomes than younger patients. In this episode Dr. Zara Cooper (acute care and trauma surgeon at Brigham and Women’s hospital) and I discuss some of the reasons for this, and also ways … Continue reading

Posted in Medications and Adverse Drug Events, Trauma | 3 Comments

Preventing Falls in the Elderly: An EMS Story

The risk of falls increases as we age. Unfortunately, so does the risk of injury, morbidity, and mortality following a fall. Falls risk is considered a geriatric syndrome, with multi-factorial causes. Falls are a the #1 cause of trauma-related mortality … Continue reading

Posted in Medications and Adverse Drug Events, Systems and Administration, Trauma | 2 Comments

How to Reverse Oral Anticoagulants

The number of new oral anticoagulants has grown dramatically in the last few years. And with that growth has come the need for new reversal agents. Reversing anticoagulation in patients with acute intra-cranial hemorrhages can be complex and dependent on … Continue reading

Posted in Medications and Adverse Drug Events, Neurology and Psychiatry, Trauma | 3 Comments

Pearls and Pitfalls of Pain Management in Older Adults

Pain is the number one reason why people seek care in the Emergency Department (ED). One major goal of acute care is diagnosing the cause of the pain, but another is helping relieve the suffering associated with pain. In older … Continue reading

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Dangerous Med Combos in Older Adults

Look twice at the med list before you prescribe these! Two distinguished guests join me this month, David Juurlink (@DavidJuurlink) and Bryan Hayes (@PharmERToxyGuy), to discuss medication interactions. There are many medications that we commonly prescribe in the ED that … Continue reading

Posted in Medications and Adverse Drug Events | 1 Comment

Hip Fracture Management Pathways in Older Adults

Hip fractures are a common injury among older adults and have a staggering one-year mortality of 20-30%. In this episode we discuss a multi-disciplinary pathway to improve the acute care of patients with hip fractures. It can help standardize care, … Continue reading

Posted in Medications and Adverse Drug Events, Systems and Administration, Trauma | 4 Comments